HIMSS’19: Real Value in Telehealth and Virtual Care

This is the second in a series of blog posts recapping HIMSS’19; you can read all our coverage here.  

My primary purpose at HIMSS’19 was gathering information and ideas for our upcoming report on the front door to care. This report will take a close look at the evolving ways patients first enter the healthcare system. Whether from retail health, telehealth, remote patient monitoring, or remote care apps, HIMSS was full of changing ideas and approaches. The conference had a utilitarian focus, looking less at generic or abstract buzzwords to get people excited, and more at what can be done right now to engage providers, payers, and ultimately patients.

My biggest takeaways:

Telehealth, Remote Monitoring, and Virtual Care can significantly erode established HCO business models, or complement them.

Health systems have invested a lot into controlling referrals and leakage. While the PCP remains the central organizing hub of most healthcare, the growth of retail and remote health could lessen the PCP’s centrality in traditional referrals networks.

Unlike the Teladoc model, which employs contracted providers to provide a turnkey outsourced telehealth service, newer entrants offer operational platforms and back-end systems so HCOs can staff and run their own telehealth programs. This allows them to retain control of the patient experience. It’s an easier model for an HCO to understand and use, but whether they adopt such solutions before their competition is an open question.

Behavioral health might finally get its due through Virtual Care apps.

Between shrinking reimbursements and scarce providers, behavioral and mental health care have been the first service line on the chopping block for a while now. PCPs have become the go-to provider for too many behavioral health needs, occupying increasing amounts of time and stretching their expertise thin.

Several of the telehealth and remote health platforms I saw last week had behavioral health components. There were a few well-executed apps dedicated to mental health and wellness, mainly with a CBT/DBT focus and some with solid clinical results. Helping PCPs manage this care and mitigating the effects of comorbidities on patients is an important part of addressing PCP workload and job satisfaction, as well as patient engagement. These virtual care offerings can help struggling PCPs get their patients the help they need, while still working within tight budgetary and scheduling restrictions.

Telehealth, Remote Monitoring, and Virtual Care can significantly erode established HCO business models, or complement them. The question is whether health care systems will recognize that in time.

Performance improvement services are becoming a core component of analytics products

With my background in healthcare performance analysis and improvement, I wanted to see how analytics is evolving to become more effective and efficient.

The future of analytics platforms looks less like pre-built dashboards or reports and a lot more like what Visiquate offers. Its embedded employees work directly with customer end-users to execute Agile-inspired improvement sprints supported by their analytics and reporting. Vendors are coming to grips with the challenge of operationalizing analytics for value and performance improvement. The value proposition behind both improved reporting software and process improvement is pretty well understood. Figuring out how to fit it all into an annual budget in an era of shrinking margins is the real hard part here.

Leveraging data to produce specific, actionable recommendations remains a challenge.

A fascinating conversation about AI at the Geneia booth on Tuesday afternoon summed up the current state of AI and machine learning in the clinical world. While access to existing and new kinds of data is increasing and the ability to integrate it is getting more sophisticated, AI and ML still aren’t the clinical tools many expected them to be. Only imaging, an area where the datasets are complete and the challenges are well understood, has really begun to heavily leverage AI/ML. Everywhere else, the barriers to gathering appropriate context and rendering predictive clinical recommendations have yet to be overcome.

Stay up to the minute.

Did You Know?

How Healthcare Leaders Adapt to the Evolving Front Door to Care

by Brian Eastwood and Paul Nardone

When today’s healthcare consumers have questions about their health, they are no longer limited to phone calls to the doctor’s office or visits to the emergency room. Technology has enabled and supported the creation of numerous new “front doors to care” – including but not limited to telehealth, chatbots, digital therapeutics, retail health, urgent care, and community-based clinics – that threaten to disrupt traditional care delivery models.

We recently interviewed two leaders at organizations leveraging telehealth to meet patients where they are and complement existing clinical workflows:

  • Joseph Brennan, Senior Director, MedNow at Spectrum Health
  • Chris Johnson, Vice President and General Manager, Landmark Health

Excerpts of these interviews appear below. They have been edited for clarity.

Briefly describe the solution or service you offer and how it opens a new front door to care for patients.

Brennan: MedNow is Spectrum Health’s direct to consumer (DTC) telehealth program. It has been in place for four years. It lets patients see a provider on their device for low acuity primary care conditions. Custom-building a mobile app that integrates with the EHR enabled us to enhance the patient experience and complement all of the other digital tools that Spectrum Health offers.

Johnson: We describe Landmark Health as a leading-risk medical group. We contract primarily with payers but can also contract with anyone who takes on risk. We focus exclusively on patients with 6 or more chronic conditions and are available to them 24/7/365 telephonically or in their home. We have physician leaders who take care of patients and are supported by interdisciplinary teams: Case management, behavioral health, pharmacists, dietitians, social worker, and non-clinical healthcare ambassadors who help build relationships with patients in between clinical visits and help them with education.

Was the motivation to adopt a solution that would open a new “front door to care” driven by clinical, financial, or operational needs?

Brennan: All of the above. The primary driver for us creating a great patient experience is that it is quickly becoming an expectation of patients who want convenient access to care. In addition, as healthcare transitions to value-based care (VBC), cost reduction is paramount.

Johnson: The hospital business model isn’t designed to provide longitudinal care of patients with complex conditions. We designed a model from the group up that could provide care for patients when they need it (24/7) and where they need it – in the comfort of their home. Patients with complex chronic conditions have a generally steady high medical spend year-over-year, so intensive longitudinal models to improve their long-term health work well. There are also psychosocial elements, including depression, dementia as well as addiction. This can be impacted by the interdisciplinary approach – specifically the incorporation social work and behavioral health – of our clinical model.

Hospitals state outwardly that they don’t want inappropriate hospitalizations. We are not taking away their core business treating patients in need of acute care.

How did you make the case for implementing a front door to care that has the potential to adversely impact another part of the business?

Brennan: Throughout development of our program, we were very conscious of cannibalization. Telehealth takes visits out of the emergency department and replaces it with something much less expensive. In preparing our health system for the future, we would rather get ahead of reducing healthcare costs than react to it. We need competencies in virtual care for the future and chose to build it now, rather than trying to catch up later.

Johnson: Hospitals state outwardly that they don’t want inappropriate hospitalizations. If there’s a readmission, they don’t get paid the second time, so we partner with them on discharge planning. Conceptually, they’re aligned. We are not taking away their core business treating patients in need of acute care.

Which stakeholders did you need to engage when first making your pitch – and who was the hardest to convince?

Brennan: We emphasized both clinical and operational benefits. Many health systems focus on one or the other; our strategy was to focus on both. The primary resistance came from physicians who were not convinced this was an appropriate standard of care. Four years into our telehealth journey, some physicians still don’t believe that virtual care is part of the future. We can attribute much of our success to the buy-in and support of executive leadership.

Johnson: We’re something that not a lot of people have seen before. It takes a bit of time to explain who we are and assuage fears that we will be competing for members with primary care physicians. We’re not a PCP, and we encourage strong relationships with a PCP. When we enter a market, PCP visits stay the same, or even increase a little bit. Once PCPs see the effects, they realize it’s really only a small number of their panel – and it’s usually the ones they find the hardest to manage, who have a lot of barriers to care.

When we are measuring the growth of our encounters, we are thinking of it as a convenient front door to the system, so it makes sense to measure how many people come through that door. Other important metrics include new patients to the system, cost savings to payers, avoided ED and Urgent Care visits, and patient miles saved.

What KPIs or other metrics are most important to measuring the success of your front door to care initiative? Are you focused on raising awareness, boosting business, or adding revenue?

Brennan: For us, it’s the number of encounters. With virtual care, the only way to scale is through increasing volume. When we are measuring the growth of our encounters, we are thinking of it as a convenient front door to the system, so it makes sense to measure how many people come through that door. Other important metrics include new patients to the system, cost savings to payers, avoided Emergency Department and Urgent Care visits, and patient miles saved.

Johnson: Our service significantly reduces the medical expense reimbursement for a patient and improves the medical loss ratio for that covered population – from north of 100% to something quite profitable. Health plans can take a segment of members that used to be challenging and bring it in line with the rest of their book of business. This allows our plan partners to keep premiums lows and invest in additional services for their members.

How does your new front door to care reduce the friction that often makes it difficult for patients to seek the care they need?

Brennan: First and foremost, it’s access. Our average wait time for a visit is 12 minutes and we are available 24/7. MedNow sees patients regardless of having a relationship with a Spectrum Health provider and we are available to everyone in the state of Michigan.  We have created a patient experience that is easy to use so that we can provide care where and when a patient needs it.

Johnson: The patients we serve often have frequent inpatient stays, or discharges to skilled nursing or post-acute care facilities. It’s often inappropriate and ineffective care; patients leave in worse condition than when they came in. If we can manage or control these patients more effectively prior to an incident, working with their existing PCP and specialists, we may prevent a hospital visit and stabilize longitudinal health.

What do you think will be the most disruptive front door to care in the next 3-5 years?

Brennan: It’s the digital health ecosystem. Similar to Google’s digital ecosystem, it is a suite of products, not just one tool.  We will get to a point where the expectation of patients becomes that health systems will meet their needs digitally like other industries, such as banking and commerce.

Johnson: For us, it’s literally the front door. Our mission is to bring healthcare to people when they need it, where they need it. It’s simple but profound. It also allows us to bring family in. A lot of the barriers to care are around families and education and getting people on the same team. We have clinicians who can build great care plans, but also think through the barriers to care and how to ensure the patient can follow that care plan. “How can we implement this? What are the barriers? What is the family alignment that we need?” Being able to do it in the evening, on the weekend, allows us to have better conversations.

A version of this blog first appeared on the Convergence 2018 blog on September 27, 2018. 

How to Capture Actionable Patient Experience Data at the Point of Care

Key takeaways:

  • Healthcare organizations (HCOs) generally see the value of using point-of-care survey solutions to gain insight into more traditional patient experience surveys, but they don’t know how to get started.
  • HCOs will increasingly adopt point-of-care survey solutions that collect data and create insight that’s tied to their patient experience business goals.
  • Point-of-care survey vendors can add value for HCOs by offering services such as qualitative or predictive analysis, which can help HCOs identify what course of action to take next.

patient satisfaction surveyWhen it comes to our personal health, there are many things we know we need to do but often need a hand to actually start doing: Eat better, sleep more, exercise, manage stress, and so on. Without help, we stick with the status quo, even if it doesn’t necessarily lead to better outcomes.

The same can be said for HCOs aiming to improve the patent experience. They know they need to capture patient satisfaction data at the point of care, or shortly after discharge, but they don’t always know where to start. Without a point-of-care survey solution, they stick to the status quo – the retrospective, analog HCAHPS survey – even if it doesn’t necessarily lead to better outcomes.

Chilmark Research’s latest report, Capturing Patient Experience: Current Challenges and Future Needs, helps HCOs understand how to gather data using point-of-care survey solutions in order to measure progress toward achieving business goals tied to improving the patient experience. The report is based primarily on interviews with 11 Chief Patient Experience Officers (CXOs) or Directors of Patient Experience at leading academic medical centers, integrated delivery networks, and independent practice associations.

Healthcare organizations know they need to capture patient satisfaction data at the point of care, or shortly after discharge, but they don’t always know where to start.

Not surprisingly, business goals tied to patient experience are often themselves tied to the HCAHPS scores that influence reimbursement or the Star Ratings that influence reputation. The goals inform the context of the survey questions, the insight that HCOs receive from survey answers, and the actions that HCOs take in response to that insight in order to achieve their business goals. (See Figure 1.)

Figure 1: How Healthcare Organizations Gain Value from Survey Solutions

However, the actionable insight that can improve the patient experience as reflected in HCAHPS scores rarely comes from the surveys that HCOs send weeks after a care episode. That insight – related to the outcome of a procedure, an interaction with a particular physician, a bad meal, or a malfunctioning TV – comes from engaging with patients while they are still in the hospital, or shortly after they have left. Through more timely engagement, HCOs can address problems in the moment; this has the dual benefit of improving the patient experience while also resulting in better HCAHPS results when the survey eventually arrives in the mail.

In the market for point-of-care survey solutions, supply seems to exceed demand. Our report identifies more than a dozen vendors – but of the 11 HCOs we interviewed, only four currently use such a solution (one being the point-of-care offering from long-form HCAHPS survey leader Press Ganey).

Among the seven other HCOs not using such a solution, there’s a clear split between those that are considering one and those that are not. Reasons for saying “No” are neither unreasonable nor unexpected: Patients receive too many surveys, we have enough patient experience data, we have higher patient engagement and health IT priorities, we have yet to set business goals tied to patient experience, and so on.

This indicates a need for point-of-care survey vendors to better articulate the value proposition of gathering data and providing insight at the point of care, as opposed to waiting for retrospective survey data to trickle in. It also suggests that HCOs would benefit from a layer of services on top of the point-of-care survey solutions they implement. Such services could include qualitative analysis (to extract meaningful data from open-ended, text-based responses) and predictive analysis (to recommended best practices or individual interventions – and to indicate the result if an HCO fails to take action).

Read our full report to learn more about how these services (and others) help HCOs understand how gathering data at the point of care can lead to meaningful changes that improve outcomes. The report lists the Functionality, Platform, and Usability features that HCOs should look for in point-of-care survey solutions. It also describes basic and advanced use cases for all three of those feature sets, which will help CXOs understand how their organizations could benefit from the use of such solutions.

(The report does not cover how to eat better or exercise more, though we are always open to suggestions.)

What’s All the Fuss – Some Thoughts on Recent News

At times it can be challenging to draft commentary on all that is happening across this industry sector. Rather than write short posts for each, I have created an amalgamation of commentary to some of the more newsworthy announcements.

Roche Acquires Flatiron

Wow, whoever knew that data could be such a valuable resource? Roche’s total spend to acquire Flatiron Health, a company focusing on the oncology space, was an eye-popping $2.1B. At first, I just could not fathom why anyone would spend that much for a relatively young company, that despite receiving a lot of VC funding early on, had little to show other than acquiring a modest oncology EHR.

Digging deeper however I learned that Flatiron was taking all that oncology data being collected in their EHR at physician offices across the country and cleansing and normalizing the data for clinical research purposes. Clean, normalized data is hard to come by in this industry and near impossible in oncology. Upon reflection, it now appears that Roche made an incredibly savvy move, one that will reap a handsome, long-term return on investment for the company.

Veritas Capital Acquires GE Healthcare’s IT Assets

This acquisition by Veritas is a tough one to understand. Over one billion dollars cash for assets that are dated and fading from the market? Granted, there is that installed base, there is that maintenance revenue to leverage and if you strip out virtually all SG&A costs you can make some money here, but is it really worth the trouble?

Veritas’s acquisition of Thomson-Reuters healthcare business that became Truven and later sold to IBM for roughly 2x what they paid shows that Veritas may know what they are doing. Maybe combining these GE assets with Verscend (formerly Verisk Health), also under Veritas, creates a 1+1=3 scenario but right now, just don’t see it.

ACHE Congress

Attended my first American College of Healthcare Executives (ACHE) Congress two weeks ago. This is a very collegial event – warm and welcoming. Everyone is there to learn from one another through various educational sessions and seminars. It is also an event where I was a bit floored and probably under-dressed as virtually everyone was in suits and ties.

I attended several sessions, mostly on IT and innovation, to get a feel for how these senior-level executives think about these issues. Came away with a feeling that most really do not see what is coming. Along with all of those suits, one walks away with the impression that there is a certain level of calcification across this audience. Sadly, many will likely become the detritus of the digital train that will run right over them.

Apple & the Elusive Consumer-controlled Health Record

Have been taken aback by all the fuss being made about Apple’s recent announcements regarding its Health Record app. From the Twitterverse, to a wide range of trade mags, to blog posts, folks are making this app seem like the second coming – that this signals Apple’s ability to disrupt the industry.

Hold on folks.

While I certainly applaud Apple’s efforts and for that minority of the population using an Apple iOS device, this may be just what they are looking for, I can’t help but feel a deja vu moment.

Were not Google Health and MSFT’s Healthvault going to do the same thing – revolutionize healthcare, put patient’s health records into their control. We all know where that ended – in the dustbin of history.

I’ll stay cautiously optimistic, but will reserve excitement until that day when Android devices also have the same capability with both clinicians and citizens warmly embracing and using this functionality for their care and the care of loved ones.

Why Patient Relationship Management Is More Than “CRM for Healthcare”

Key takeaways:

  • Patient engagement has come a long way for those organizations looking to move beyond early models of the patient portal propped up by meaningful use – but it still has a long way to go.
  • Patient relationship management is more than just CRM for healthcare, and vendors from numerous healthcare core competencies all approach PRM from different perspectives.
  • Market fragmentation will limit widespread PRM adoption for the next 24 to 36 months – but adoption will be methodical and deliberate, not slow.

About 18 months ago, Chilmark Research published a report encouraging the healthcare industry to push patient engagement technology beyond the portal. Our report outlined how existing solutions were not ready to support the types of engagements (frequent, bidirectional, mobile, and increasingly virtual) outside the traditional healthcare setting that are necessary to provide coordinated, value-based care to patients with varying degrees of health status and technological expertise.

We predicted it would take until 2020 for solutions to support this level of engagement. By 2018, we expected to be entering an interim phase broadly defined by pilot programs, incremental improvements to functionality, and increased interest from regional healthcare organizations (HCOs) and other “smaller” players.

Well, 2018 is here, and our expectations have mostly been met, as we detail in our forthcoming report, Patient Relationship Management: Higher Stakes Than CRM (Update: Available now! The report can be downloaded by CAS subscribers or purchased a la carte). While adoption has been slower than anticipated, we have been surprised at the pace of improvement, which has been driven in large part by the emergence of vendors approaching engagement from different perspectives.

PRM adoption will remain incremental over the next 24 to 36 months. However, the pace of adoption will be methodical and deliberate, not slow.

Many factors, and many players

Due in large part to EHR implementation motivated by meaningful use, the portal has driven and enabled patient engagement efforts over the last decade. But the EHR’s original role – capturing data at the point of care to streamline billing – does not on its own lend itself to a better engagement experience, especially for engagements that do not constitute billable encounters. That’s a major reason only one in four patients access their health data electronically even though nearly 90% of HCOs offer them the ability to do so, according to Government Accountability Office data.

Numerous factors have motivated healthcare to rethink engagement in between care episodes, namely the following:

  • Shift to value-based care models and risk-based contracts (from both public and private payers).
  • Pressure to better manage (or even prevent) chronic conditions.
  • Rapid consumer adoption of mobile technology for both personal and professional use.
  • Increased patient responsibility for premiums, deductibles, copays, and other out-of-pocket costs.
  • Importance of patient acquisition and retention, especially amid HCO merger and acquisition and in competitive markets.

With numerous motivations to rethink engagement, it shouldn’t be surprising that vendors with multiple core competencies have stepped up to help HCOs rethink engagement. All told, Chilmark Research identifies seven core competencies, all of which contribute to or have a place in a theoretical “stack” of functionality. Vendors traditionally focus on one of these seven sub-segments of engagement. (See Figure.)

To provide a complete engagement solution, information should flow freely among the stacks. And information should be comprehensive: Care plans, in-network service eligibility, medication reminders, synced device data, care gaps / social determinants of health, intake forms, and specific condition management interventions – the list goes on.

As reflected in the title of our report, we refer to this collective stack as patient relationship management. The name is similar to customer relationship management, but true PRM is more than just “CRM for healthcare.”

Yes, PRM uses predictive modeling to identify patients to target with products or service offerings, as CRM does. Yes, PRM measures the downstream results of these targeted offerings and lets HCOs modify engagements accordingly, as CRM does.

However, CRM’s support of the “customer journey” is largely limited to the products, services, and people that a particular company (plus its closest partners) has to offer. To support the “patient journey,” PRM must extend beyond what an HCO traditionally offers. It must intersect with patients’ needs outside of the HCO setting, in between care episodes, as they live their everyday lives.

Filling the gaps

As noted, vendors’ efforts to support the patient journey typically focus on one of the seven sub-segments of engagement functionality. This has caused substantial fragmentation: Not only is there no dominant vendor across the sub-segments (out of at least several dozen PRM vendors in all), there is no dominant sub-segments of vendors as a whole.

This high degree of fragmentation is set to impact the PRM market over the next 24 to 36 months in three key ways.

One, PRM adoption will remain incremental. However, we would describe adoption as methodical and deliberate, not slow. HCOs will look for solutions that address clear patient engagement problems, whether it’s low scores on quality metrics, poor outcomes after elective surgeries, or large and disengaged prediabetic populations. HCOs will want vendor partners for pilot projects – but they will want mature partners for fully baked pilots. The process of throwing projects to the wall to see if they will stick will be left to internal innovation centers or early-stage startups working with affiliated incubators.

Two, PRM vendors will fill the gaps in their solution sets in order to demonstrate that maturity. Some vendors will opt for internal product development – such as EHR vendors continuing their pivots toward analytics, care management, and population health management. Most, however, will focus on partnership with leaders in other core competencies (particularly education, messaging, and personal health record management) as a way to fill these gaps.

Three, with both the appetite for IPOs and the prospects of unicorn-like growth softening, many single-function PRM vendors will face the choice to get acquired or go out of business. (To be fair, the same is true of point solution vendors across the entire digital health landscape.) This uncertainty may temper HCO enthusiasm to invest in an unproven vendor – or one that has succeeded enough to catch the eye of potential buyers.

Progress, but work to be done

These PRM market trends suggest that our prediction from the fall of 2016 holds true in the winter of 2018. We are still more than two years away from widespread adoption of comprehensive patient engagement solutions that can support coordinated, value-based care.

To do this, PRM solutions need to do two things:

  • Meet patients where they are. The industry is getting there – and, admittedly, faster than we had anticipated 18 months ago. Bidirectional messaging and appointment scheduling, two of the biggest “asks” that patients have, are widely available in PRM solutions.
  • Help patients manage their health and wellness on their own terms, outside the HCO setting. This has proven more difficult. PRM is making strides in these areas, by offering access to care plans and integrating medical and fitness devices, but support is neither widespread (not all vendors offer it) nor universal (not all vendors that offer it do it the same way). Plus, mere access to a care plan is not the same shared responsibility for a care plan – which is also not the same as self-sufficiency.

Progress has been made, but PRM vendors and HCOs still have work to do to meet patients’ needs. Our report provides many more thoughts on what it will take to make that happen. In the meantime, we welcome your thoughts.

What We’ve Been Commenting On

Lately, there have been quite a few big developments in healthcare, including Allscripts acquiring Practice Fusion, Apple’s PHR, and the mysterious Amazon-JP Morgan Chase-Berkshire Hathaway healthcare company. Not all of these developments have enough detail yet for Chilmark to analyze the impact on the future of the health IT market in-depth, but we are commenting elsewhere on the wider possibilities for the healthcare industry.


Blockbuster digital health funding to spill to 2018
Brian Eastwood in HealthcareDive
“’We think next year is when we’ll begin to see [predictive analytics] go beyond simply accounting for and noting social determinants of health and barriers to care and start to use that information to inform care plan decisions,’ Eastwood said. Vendors able to adequately take this on will emerge as key players in the care management and population health markets as the year progresses, he added.”

Health IT eyes M&A as market grows up
Ken Kleinberg in HealthcareDive
The EHR market is saturated [and] consolidation is very clear…The movement to analytics and population care, that’s where the action is now,” Kleinberg said. “There’s a tremendous amount of innovation still possible.”

Apple debuts medical records on iPhone
Brian Eastwood in HealthcareDive
“Apple is widely accepted as understanding the user experience,” Eastwood said. “If all of the sudden, a substantial chunk of the population has the capability to tap into a patient portal in a way they haven’t before, then it could be a gamechanger.

Why AI tools are critical to enabling a Learning Health System
Ken Kleinberg in HealthcareIT News
The Learning Health Systems continually improve by collecting data and processing it to inform better decision making. As the amount and complexity of big data continues to increase, organizations are challenged to fully take advantage of it,” said Kleinberg. “AI systems are particularly suited to analyze huge data sets to discover meaningful and actionable insights, and even to carry out actions.”

Apple steps into Epic System’s arena with medical records iPhone app
Brian Eastwood in The Capital Times
“(Health record companies) will still be building their core products,” said Eastwood. “They’ll still be maintaining the records…[Regarding rumors of Apple or Amazon creating EHRs], right now, it’s still a little bit in the realm of fantasy.”

How Amazon, JPM and Berkshire could disrupt healthcare (or not)Health IT eyes M&A as market grows up
John Moore in HealthcareDive
“‘I’m not holding my breath for big changes,’ Moore said. Instead, he expects incremental change are more likely over the next three to five years.”

Will Amazon’s push into health care impact Epic Systems’ future?
Ken Kleinberg in The Capital Times
“Software to power the applications for health care providers come predominantly from a few large players like Epic and Cerner,” Kleinberg wrote. “It’s a great question to ask to what degree they can take their provider and software application expertise and apply it to the needs of payers.”

What Digital Health Investors Should Learn From the Flu

Successful startups will define a problem and solve it, not just prove a concept


By many accounts, the digital health market remains strong. Both Startup Health and Rock Health reported substantial year-over-year upticks in VC funding announcements, at 44% and 31%, respectively. (Startup Health assessed $11.5 billion in global deals, while Rock Health looked at U.S. deals worth nearly $6 billion.) Digital health vendors had a heavy presence at this year’s Consumer Electronics Show as well.

Look a little closer, though, as investor lawsuits and lax evidence seem to suggest that strength might be starting to crack. Both startup incubators omitted the maligned Outcome Health from their assessments; the company, which received $500 million in funding last May, now faces fraud lawsuits from those same investors. The omission suggests that future digital health deals should expect additional scrutiny – but it also raises the question of how closely Outcome Health was scrutinized in the first place.

CES 2018 gave the healthcare industry solutions in search of real problems. Meanwhile, the stark reality of the flu in the United States presents a real problem that could benefit from a variety of tech-enabled solutions.

At the same time, the Startup Health and Rock Health assessments include Peleton, which with $325 million in funding received one the biggest deals of 2017. Peleton makes a $2,000 stationary bike and demonstrated a $4,000 treadmill at this year’s Consumer Electronics Show – monthly subscriptions to on-demand workouts not included. Peleton’s inclusion on a list of digital health vendors is, at first glance, a bit dubious:

Peleton’s treadmill was part of a long list of digital health demos at this month’s CES 2018. During the show, the contents of this list showed some promise – devices tracking sleep, wearables measuring biometric data, and voice assistants helping with everyday life. Under the bright lights of the Las Vegas Convention Center, the use cases were clear.

It didn’t take long for the lights to dim. Take these two research papers that came out days after SEC: One found “no statistically significant impact of remote patient monitoring on any of six reported clinical outcomes” – not the desired results. The other found the healthy and wealthy to be the most likely users of sleep tracking apps – not the desired demographic.

As for the voice assistants, a CNBC technology writer suggested that, at this stage, they are proofs of concept and not yet tangible products. LG and Samsung think it would be cool for you to if you could talk to your appliances – to get useful information, that is, and not simply to curse when your toast is burnt. Moen thinks it would be cool if you could talk to your faucet. It’s useful, sure, but it’s little different than what your smartphone already offers – and it doesn’t require replacing a refrigerator or bathroom faucet.

All these vendors face the same challenge that Apple faced in 2007 with the original iPhone: Convincing people that they need something before they really know what “something” is. The market’s just not there yet.

Outside the Las Vegas Convention Center, life (cough) goes on

While CES 2018 gave the healthcare industry solutions in search of real problems, headlines proclaiming that this year’s bad flu season is poised to get worse present a real problem that could benefit from a variety of tech-enabled solutions. With hospitalizations on track to top 700,000 in this flu season, and on the 100th anniversary of the outbreak of the flu epidemic that infected one-third of the world and killed 675,000 Americans, it’s not time to sit still.

A comprehensive and multi-modal approach could help healthcare rise to the occasion:

  • Readily available and easily understandable educational material about flu prevention, shared months before outbreaks typically hit and distributed to patients through multiple channels, not just a portal message.
  • Incorporation of flu prevention into wellness visit protocols, complete with a new CPT code that covers flu prevention (not just vaccination) as well as public and private payer reimbursement for virtual visits (outside of the chronic care management CPT code) that address flu prevention.
  • Honest information about flu vaccines that addresses two facts: That healthy patients should still get shots, to protect those around them at greater risk (also known as herd immunity), but also that shots don’t protect against all flu strains.
  • Alignment of provider, payer, and employer incentives for getting flu shots but also taking additional preventive measures, as tracked and measured through a wellness app, portal, bidirectional messaging, or other consumer-friendly means.
  • Increased use of CDC and other government flu-tracking data, as well as social media data, in real-time predictive models to help health systems forecast when flu cases will pick up, coupled with automated alerts to affiliated practices about what to expect and what precautions to take.
  • Broader integration of retail health, telehealth, and urgent care services with traditional health systems to ease the ED’s flu treatment burden – and to reduce the exposure of a flu patient with a compromised immune system to other diseases that present in the ED.

Some vendors have already taken up the task. Smart thermometer maker Kinsa is crowdsourcing its data, which the company says outpaces the CDC’s data releases by several weeks. Meanwhile, athenahealth has been tracking data from the practices on its network since 2013 – when a government shutdown left the CDC unable to track flu data on its own.

Emphasize problems, and the value of solving them

We do not present this punchlist of problems to suggest that digital health vendors should drop their sensors and algorithms and immediately pivot to the flu. Rather, they need to focus solution development on a specific problem and the value that they add to solving the problem. The unmet needs of flu prevention and treatment simply illustrate the breadth and depth of a single problem and the numerous ways that digital health can provide a solution to that problem.

Wearables, trackers, voice assistants – and, yes, even stationary bikes – could play a role in solving some of healthcare’s problems: Physical inactivity, health education and literacy, data collection, condition management, messaging, access to care, and a host of other issues.

The challenge for startups, as well as the investors that fund them and the incubators that advise them, is articulating a vision for how these solutions add value to healthcare as a whole. After all, if solutions fail to define their value, the market will define it for them.

Chilmark Research will continue to examine digital health this year, whether at industry events such as HIMSS18 or our own Convergence or through research projects on topics such as virtual care models. We look forward to conversations with those who have been bold enough to define their value.

After all, that’s what separates a proof of concept from a product, and that’s what will drive digital health investment in 2018 and beyond.



Salesforce Enters the Fray: Will They Succeed Where Others Have Failed?

Chilmark Bight

After several years of circling the healthcare market, Salesforce finally announced its intent to formally enter the market this week with the announcement of Salesforce Health Cloud. Unlike other enterprise vendors who have jumped into this market, with Blue Ribbon advisory panels (Google Health), or series of acquisitions (IBM Watson Health, Intuit) or a mixture of both (Microsoft), this announcement by Salesforce had little in the way of any of these attributes to bolster its announcement.

Salesforce is taking a much more tentative and low risk approach to entering the healthcare market and will look to its expansive ecosystem of partners who will leverage Salesforce’s existing tools to create healthcare specific solutions and services.

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